CPCs Unplugged, Part 2: Free Ultrasound, But At What Cost?
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Tue Aug 22, 2006 at 02:50:52 AM EST
"A Picture is Worth a Thousand Words"

Photobucket - Video and Image HostingThat's why the Pregnancy Resource Centers of Greater Portland ensure that "Free ultrasound exams are available to all abortion-vulnerable clients in all six locations."  Despite token disclaimers of performing ultrasound only for "medically eligible" clients, countless other unregulated crisis pregnancy centers across the country follow the same non-medical protocols.  

A human price could be paid for the thousands of medically unjustifiable "free" ultrasound exams performed in CPCs -- "pro-life ministries" sponsored by the religious right and financed by public grants -- that fly below the radar of FDA regulation.

Troubling studies have repeatedly demonstrated [pdf link] that prolonged exposure to ultrasound can produce damaging effects upon the tissues of the developing human fetus.

A 1993 study published in the Lancet cautioned that it was "plausible" that multiple ultrasound scans were responsible for retarded fetal growth. In a 1990 article, Dr. Kenneth J.W. Taylor -- Professor of Diagnostic Radiology and Chief of the Ultrasound Section at Yale University School of Medicine -- said, "I would not let anybody get near my infant's head with a transducer unless I knew what the output was."  

Good advice, since a 2001 Mayo Foundation study found that prenatal ultrasounds expose a fetus to sound levels registering at 100 decibels, as loud as "a subway train coming into a station." And University of Calgary researchers concluded that "[a]n association between prenatal ultrasonography exposure and delayed speech was found."

Now new research strongly suggests that overexposure to ultrasound affects fetal brain development, contributing to disorders ranging from "mental retardation and childhood epilepsy to developmental dyslexia, autism spectrum disorders and schizophrenia." The researchers' conclusion is that "ultrasound ... exposure should be kept low and unregulated uses should be avoided."

Dr. Joshua Copel, president-elect of the American Institute of Ultrasound Medicine, states it plainly: "Anytime we're doing an ultrasound, we have to think of risk vs. benefit. What clinical question are we trying to answer?"

But CPCs that perform ultrasound have a question of their own: "What do we have to do to prevent a woman from having an abortion?"  

Just as they did last week in Crisis Pregnancy Centers Unplugged, CPC operators answer that question in their own words.

[Unless otherwise attributed, all quotations are from emailed communications publicly posted and available online at PCC Talk.org.]

How does a cash-strapped CPC "ministry" manage to afford an expensive ultrasound machine in the first place?  Over 200 of them have simply called up Dr. James Dobson, whose Focus on the Family writes them a check for 80% of the cost.

I am the ED [executive director] of a PRC that just completed "going medical". We participated in the Focus on the Family Ultrasound Project and received our machine in late September. ... To date, every expense has been met.  We projected that it would cost us $20,000 (based upon figures given to us by Focus) to get converted.  
I would highly recommend offering this service.  It is not as scary as it seems at first.  If you participate in the Focus on the Family project, they are there to help every step of the way.  ...  I suggest that you contact Focus as your first step.

A typical center in Anchorage offers ultrasound scans for reasons that please Dr. Dobson, but would fail to pass muster with Dr. Copel.  This CPC promotes its free ultrasound scans online by appealing to women's fears that something might be wrong - something such as ectopic pregnancy [Is my pregnancy located where it should be (in the uterus--not in the tube)?] or miscarriage [Is my pregnancy progressing? (The miscarriage rate in early pregnancy can be 1 in 5.)].

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The ostensible reason that CPCs such as the Crisis Pregnancy Center of Metro Richmond offer ultrasound is to give a woman the information she needs to make a choice, even though only one choice is on the table.

The procedure takes about 30-45 minutes and offers valuable knowledge during pregnancy. At the CPC our goal is provide you with accurate and up-to-date information about pregnancy and abortion so that you can make a fully informed decision ...

That's right -- 30-45 minutes of ultrasound exposure for a simple scan that, in the hands of a qualified technician, takes less than ten. Of course, in CPC World, a trained ultrasound professional is someone who takes an online course from the National Institute of Family Life Advocates (NIFLA), which also provides advice on potential legal liability for CPCs and includes a link to the American Institute of Ultrasound in Medicine, vaguely implying an AIUM endorsement of its practices.

But this is the official statement of the AIUM regarding fetal ultrasound performed for what it calls "psychosocial" or "bonding and reassurance purposes."

The AIUM recommends that appropriately trained and credentialed medical professionals (either licensed physicians, registered sonographers, or sonography registry candidates) who have received specialized training in fetal imaging perform all fetal ultrasound scans. These individuals have been trained to recognize medically important conditions, such as congenital anomalies, artifacts associated with ultrasound scanning that may mimic pathology, and techniques to avoid ultrasound exposure beyond what is considered safe for the fetus. Any other use of "limited medical ultrasound" may constitute practice of medicine without a license.

Now that we're clear on what does and does not constitute a medical indication for fetal ultrasound, and who is and who is not qualified to perform it, let's sit back and listen to CPC operators dish about their own medical and ethical standards.  

And isn't it reassuring to learn that some of them make at least an outward show of compliance?

How do you medically justify more than one US [ultrasound] if you know it is a viable IUP [intrauterine pregnancy]??

Please email me PRIVATELY!!!  DO NOT RESPOND ONLIST!  This is to keep your answers secure.

There are ways to get around some of those pesky state medical regulations -- you know, the same rules that CPC defenders complain aren't tough enough on the medically regulated, state licensed and stringently inspected clinics that have physicians on site and provide accurate, factual information about pregnancy, contraception and abortion care.  Yes, indeed, even for "medical" CPCs, there are ways.

In NJ we are not required to be licensed if doing U/S less than 8 hours per week.  So, we had an RN trained at Shari Richards week long U/S class and put together a Medial [sic] Policy and Procedure manual (a combo of CareNets and NIFLA's).
Our Corvus 260 U/S machine was a $23,000 model, new 1 year ago.  We received a NJ grant for it.

No license, and no state regulation or oversight, even though this CPC, like so many others, is doing ultrasound exams with the state's money.  Still, it's too bad that "abortion vulnerable" doesn't have its own diagnosis code in the ICD-10 manual. Because at A Woman's Concern near Penn State, the most overriding medical indication for a sonogram seems to be catching pregnant students before they get away.

Our ultrasound tech does scans as early as 5 1/2 weeks because he can see a sac at that time and our college women are eager to know anything. We have a chance to gain trust and ... [w]e never have any trouble getting them to come back in a week when we hopefully will see further development ... . We have found too many times if we ask them to wait for that initial visit they will never come.

That's two exposures of a very early, very fragile embryo to potentially damaging ultrasound in one week, simply because, if a young woman doesn't come into the CPC right now, she might not come in at all.  

A CPC in Concord, California, has the same problem, and applies the same non-medical ethic in resolving it.

Whether to put off an ultrasound for a week or two is a gray area. If the client seems strongly abortion minded, I would try the ultrasound right then, if they will allow me to do a vaginal one. If they do not seem strongly abortion minded and they are less than 6.5 weeks I might try to schedule them to come back in a week.

We found at 5-6 weeks we can't visualize the baby well enough to make an impact. It's not that the baby is a "blob", it just that the baby is very tiny and still way down in the pelvis and ... difficult to capture adequately on our older ultrasound and with our limited training.

But even outdated machines, limited training and utter disregard for medical guidelines don't tell the whole story on lack of "impact." When the subject is CPCs, there's always more.

[W]e here in Roanoke, VA, have been talking about how effective our ultrasound machine has been in helping clients to change their minds.  I don't know about you, but when I first started hearing about the push for CPCs to go medical, the numbers pertaining to client impact seemed astronomical!  All of the reports I heard indicated that if a woman saw her baby via ultrasound, the chances that she would change her mind and carry the baby skyrocketed!  

In Roanoke we have not seen this happen and we're trying to figure out why.


According to a colleague in Texas, the Roanoke center's numbers are down because they aren't doing post-sonogram "counseling" with shock-graphic videos so gory that they cause controversy even among the most strident anti-choicers.  

We in Beaumont, Texas have been using ultrasound for 3 years and our success rate is running 95%.  The key is agressive [sic] counseling immediately after the sonogram.  We have "Harder Truth" ( the video) if needed ...  Again, the key is to have another counseling session with them after the ultrasound in the form of an "exit intension" [sic].

Medical necessity for ultrasound is what the CPC's medical director says it is, and Alternate Avenues in Upland, California has a simple protocol to weed out the moochers.

We only provide free ultrasounds to clients we consider "at-risk" [for abortion] because the standing order from our physician states that is what makes it medically necessary.

We never perform ultrasounds for clients who are pregnant and just want to see their baby. We simply tell them that under doctor's orders, we don't perform ultrasounds for any other reason except when medically necessary. So far they seem to accept this explanation.

That's about what you'd expect from a physician who tells women that emergency contraception is the same thing as medical abortion, and that "women who abort face a 50% increase in breast cancer" and up to a 50% higher risk of suicide.  

The business manager of yet another center worries about squandering its resources . . .

Can you all share with me the time frame you use to schedule the ultrasound of an abortion vulnerable/minded client.  The # of weeks along.  Some discussion I've heard is that if the US is done too early then the client only sees a "blob" and will have the abortion.

. . . and finds understanding from a CPC nurse in Clarksville, Tennessee.

We started out using 6 weeks as our guidelines but were soon noticing that several of our clients were not as far along as they thought. ... If you perform them too early, you run the risk of exactly what you mentioned.  The client thinks, "Well, there's nothing there...just like I thought".  Because of this we changed our guidelines to a minimum of 7 weeks.

However, it's really a fine line to tread.  You don't want to wait too long either because she may never come back.

One nurse isn't concerned about possible harm to a fetus, but does worry about legal liability if her CPC upgrades to the new "3-D" or "4-D" ultrasound technology merely for "entertainment" purposes. And besides, a more detailed image could reveal fetal anomalies that motivated a woman to have an abortion.

I do not feel that the 3-4 d. technology is necessary for what we are here to do.
Because we are mostly staffed by volunteer nurses "trained in limited ultrasound."  I wonder if the "entertainment" risk is worth it or necessary.  

I think that this issue much thanks to Tom Cruise will be coming out more this year!!. ( auim site on there [sic] thoughts about this!!!   Yes I want my girl to bond with her baby and choose life!!!  but at what legal risk??  I wonder if my center is being put More at risk by handing out 3 d images.  

They frequently are to [sic] early to be clear anyway, but can I fully note a heart anomaly, spine or cephalic problem, or other things more easily seen on a 3 d image?  I have not had the training to do so. But don't want a client to see these things often easily recognized in 3 d and decide to abort because of them (like cleff [sic] lip or pallette [sic])!

But "entertainment" sonograms aren't going away anytime soon, because they're a favorite tool for CPCs that need to beef up their budgets.  No fund-raising banquet seems complete these days without a live ultrasound demonstration to impress potential donors, as is revealed in this email exchange.  

Oh my gosh you wouldnt [sic] be open to doing an ultra sound at our banquet, would you? That would be so cool. We will have our peer mentoring group there and it would be cool for them to see it also. ... Please let me know if you would be willing and what you charge.

I've never performed an ultrasound at a banquet before but that doesn't mean I would not.  
Another option for you is Connie Ambrecht of Sonography now. ... She also performs ultrasounds for banquets.

The third option is to do what we did last November at our banquet.  We wanted to showcase our new machine and what we were moving toward with our new ultrasound ministry.  ...  We have two pro-life OB/GYN's that work with us and these two men actually performed the ultrasounds with me assisting.  NOTE:  VOLUNTEER PHYSICIAN, NO FEES INVOLVED!!  
Approximately one week before the banquet, each performed a "practice" ultrasound on our model to familiarlize [sic] himself with her specific case.  The night of the banquet, we had our model and physician arrive about 30 minutes before the seating started and did one more quick "run-though" just to make sure everything was okay.  It worked out so beautifully ...   Our model was 12 weeks pregnant.  We joked with the audience that our model's baby was the most photographed baby in Clarksville!

Dr. Copel of the AIUM takes a stern view of unregulated sonography: "We don't know what equipment they're using, what the acoustic output is, and what the training of the personnel is." And with the federal government's embrace of the religious right's CPC ministries, the FDA has stopped enforcing its own rules on ultrasound output and exposure.

We can only hope that everything turns out all right for the "most photographed baby in Clarksville," and for all the others.

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But if the "culture of life" really cared anything about fetuses except making sure that women carry them, they'd care about whether they could be inflicting irreparable damage on babies before they're even born.

[Title image from Georgetown University Hospital]

Huang et al. (1994) examined the biological effects of diagnostic ultrasound on the embryo with gestational age of 6-8 weeks prior to induced abortion. They found various degrees of change in the ultrastructure of the chorionic villi in those exposed to ultrasound for between 10 and 30 minutes, with the most significant changes in those exposed for 30 minutes.

Feng-Zeping et al. (1996) irradiated fetuses at 20-28 week gestation with diagnostic ultrasound prior to abortion. Those irradiated for 30 minutes showed microscopic damage to the fetal testes.

CPC scans lasting 30-45 minutes are completely unnecessary, of course, aimed only at emotionally manipulating the woman, but they could be doing real harm to her embryo or fetus, too.

by moiv on Tue Aug 22, 2006 at 03:43:45 AM EST

It is amazing how oblivious zealots can be as they pursue their aims.

by Frederick Clarkson on Tue Aug 22, 2006 at 12:31:35 PM EST

I have actually been to a clinic like that and the sonogram was 10-15 minutes.  It did take 45 minutes but that was because they talked to me before and afterward.  I liked it there.  I ended up miscarrying and didn't have to pay for an abortion.  It was a huge relief.  Maybe I had a better center than the ones you were talking about.  I don't know.  I just know I was thankful in the end to have gone there.

by star28 on Fri Sep 01, 2006 at 05:19:32 PM EST

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